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A large multinational study found that gabapentinoids don't appear to cause a sustained increase in fracture risk in older adults — but the picture gets more complex when opioids or benzodiazepines are added to the mix. Fracture risk was actually highest in the 90 days before starting treatment. Clinicians are urged to assess fall risk upfront and start at low doses.
A new study published in The Lancet Healthy Longevity offers some reassurance — with caveats — about gabapentinoid use in older adults. Researchers analyzed data from over 22,000 patients aged 60+ in the UK and South Korea who were hospitalized for fractures between 2003 and 2020. Surprisingly, fracture risk was highest in the 90 days before patients even started gabapentinoids, suggesting that the underlying condition driving the prescription — not the drug itself — may be a key risk factor.
Once treatment began, fracture risk was elevated in the first 60 days but did not sustain or increase further over time. The real concern? When gabapentinoids were combined with opioids or benzodiazepines — a common real-world scenario — fracture risk climbed significantly.
By the Numbers:
Why it matters: For clinicians prescribing gabapentinoids to older patients, this study reinforces the importance of fall-risk assessment before initiating therapy, starting at low doses, and treating any patient on concurrent opioids or benzodiazepines as high-risk for fracture from day one.
